Technology is advancing and changing our lives at an incredible pace. The smart phone, nanotechnology and other breath-taking innovatons are being incorporated into a wide variety of industries and activities--and healthcare is at the cutting edge. Google Glass has been identified as important innovation that can play a key role in medicine--from education to telemedicine. But until now, the true application of Google Glass has been exclusively in the transmission of images and data as a proof of concept. However, the recent use of Glass in an actual clinical intervention has proved its value--and perhaps even clinical necessity.
Google Glass and the emerging role of the "telementor"
Meet Mr. Ronnie Ferrari. He's a 63-year-old gentleman with past pneumonectomy. Mr. Ferrari was admitted to the hospital with increased shortness of breath. He was diagnosed with platypnea orthodeoxia syndrome and on his subsequent echocardiographic studies, he was found to have a large patent foramen ovale (PFO) with an atrial septal aneurysm and large right to left shunt. Those are the big words--the technical description. Simply put, Mr. Ferrari had a hole in his heart and the the abnormal blood flow was taking its toll.
But here's where it gets even more interesting. The repair was completed in the cardiac cath lab using the Amplatzer septal occluder and the the technical skills of the interventional cardiologists at the University of Arkansas for Medical Science, Barry Uretsky, MD, Abdul Hakeem, MD and Christian Assad-Kottner, MD were "digitally augmented" by Eudice Fontenot, MD an experienced expert in PFO repair at the Arkansas Children's Hospital. In this unique case, Dr. Assad-Kottner , wearing Google Glass would include--by live-streaming--Dr. Fontenot participation from another location. The goal: to obtaining live recommendations through a “telementor” scenario that leverages both the "on-site" clinical skills with an "off-site" thought leader. The details of the procedure are provided in Dr. Assad-Kottner's blog.
Originally the team considered to stream the video to the outside hospital where Dr. Fontenot would be located. After discussion, and considering that Google Glass is in beta testing in addition to possible wi-fi issues secondary to leaded walls, it was decided to perform the stream to a location that would allow Dr. Fontenot to be readily available in case his expertise was needed.
An unremarkable procedure until...
The two cardiologists were scrubbed while an interventional cardiology fellow would be livestreaming the procedure to the nearby “telementor”. The decision for the interventional cardiology fellow to use the over the head mounted display (OHMD) instead of the first and second operator was due to his familiarity with the device. Once the procedure started and connection with Dr. Fontenot was established, the two physicians introduced and advanced the Amplatzer device to the right atrium, a transesopahgeal echocardiogram was simultaneously being performed which revealed an apparent artifact on the edge of the device suggestive of a clot. If the clot broke free, it could travel to either the lungs or the brain resulting in a devastating clinical consequence. Fontenot reacted quickly and advised the team to remove the device and eliminate the clot. The device was retrieved and the clot was visualized and removed. Dr. Fontenot then guided the team via "livestream" on the steps on cleaning the device and next steps to proceed. At this point the proof of concept had been established. Due to the described event and connectivity problems it was decided to ask Dr. Fontenot to enter the catheterization laboratory to further assess the situation.
The case was continued unremarkably and the the heart defect was repaired. Mr. Ferrari has now been discharged from the hospital with significant improvement in his condition and ready to start physical rehabilitation and follow-up.
The powerful perspective of the patient
Ronnie Ferrari believes that technology like Google Glass can play a very important role in patient care and like his doctors, believes that it's an important advance in care. And his expressive smile as he wears Glass is a reflection of that enthusiasm. He's a believer and the benefits to him and his family are clear.
Mr. Ferrari quickly understood the potential of having an expert telementor provide his advice and recommendations live to the interventional team. “If technology like this can help the doctor, I do not see a reason why not to use it.” He was extremely willing to participate and in addition he wants other people and patients know how this technology helped his case and how it can do the same in other situations.
Dr. Assad explained to him how the information was going to be transmitted, that Google Glass was going to use hangouts, and that the possibility existed of his livestream being compromised and seen by others. He simply said, “I understand, and if this could help in my procedure, I have no problem.”
Once the procedure was performed successfully Assad had a talk with his family the next day. He explained to them in more detail how glass had helped communicate with the telementor and obtain valuable advice during the procedure. He also allowed them to wear glass and explained to them how the dynamic works. The family members were also enthusiastic. “Technology like this should be incorporated in a quicker pace in the hospitals to help doctors” Mr. Ferrari, as well as his family, awere happy and willing to share their experiences and they believe that this technology holds tremendous potential in the not so distant future.
Implications and considerations
As we've learned from the roll out of the electronic medical record, there are three key steps that must be accomplished.
- Step One--Technological development.
- Step Two--Integration into clinical practice
- Step Three--Improved outcomes
The prior use of Google Glass has been focused around steps one and two. The "proof of concept" has been clearly established in various testing scenarios. But this recent application of Glass has changed the game. Assad and his associates have pushed the utility of Glass and, most importantly, improved an outcome. The telementor has the potential to become an "essential partner" who can provide supplemental care and insights across a hospital building or the world. Underserved regions of the globe may have new "eyes, ears and brains" to aid in care. Certainly, one case doesn't validate anything. But "a first" can act as the catalyst for change and push medicine in new directions.
Questions still remain--important questions at that. The role of privacy and the open transmission of patient information, sustained connectivity and signal strength (remember, a cath lab is often in the basement and shielded for radiation), legality of consultation across borders and the complexities of individual hospital rules and regulations. Nevertheless, technology and human ingunity has just advanced patient care. And that's the magic of digital health.
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